Behavioral Health Care Manager I

About This Role

Manage psychiatric and substance abuse or substance abuse disorder treatment benefits through telephonic or written review to ensure access to medically necessary care in a cost-effective setting. Assess member needs, coordinate care, and evaluate outcomes to optimize health benefits.

Responsibilities

• Assess member needs using appropriate screening criteria and clinical judgment
• Ensure access to medically necessary behavioral healthcare in a cost-effective setting
• Refer cases to Peer Reviewers as appropriate
• Perform psychiatric and substance abuse or substance abuse disorder assessment
• Coordinate implementation, case planning, monitoring, and evaluation to promote quality member outcomes
• Optimize member health benefits and promote effective use of health benefits and community resources

Requirements

• MA/MS in social work, counseling, or related behavioral health field or degree in nursing
• Minimum of 3 years experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
• Current active unrestricted license (RN, LCSW, LMSW, LMHC, LPC, LBA, LMFT, or Clinical Psychologist) to practice as a health professional within the scope of licensure

Qualifications

• MA/MS in social work, counseling, or a related behavioral health field or a degree in nursing
• Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment

Nice to Have

• Previous experience in case management/utilization management with complex psychiatric/substance abuse cases
• Bilingual in Spanish

Benefits